30 November 2010

Dr Grumble arrived a little earlier than usual at work today. He left home a lot ealier because of the snow. As he trudged into the hospital he was met by an agitated cleaner. A homeless lady was in the hospital toilets and she couldn't do her cleaning. What should she do?

If you're a doctor in a hospital you will find that you are expected to be able to deal with most things. Dr Grumble took a look in the toilets. There she was: a bag lady. Around her feet were polythene bags tied at the ankles with string to keep the snow out. She was frantically trying to do her hair in the mirror because she knew what Dr Grumble would recommend.

Tuppence for a rope

These days all hospitals seem to have security men. They never used to. Security was called on Grumble's advice. By now the bag lady will be out in the snow. And it's all Grumble's fault. He can't get on with his work for thinking about her.

Posted by
Dr Grumble

11 comments:

Dr Grumble's father could remember when hospitals were more compassionate and provided a room when men could keep out of the elements. There wasn't room for them all to lie down so ropes were strung across the room for the men to lean on.

For quite a few years when waiting for the bus home after a night shift - I saw a bag lady who frequented that area.

She was an upmarket bag lady, lugging her belongings around in two wheeled suitcases - ones like the legal profession use. They must have been quite heavy and full, for she would pull one for a few yards, leave it, and go back for the other, and then would repeat the process. She would get washed in one of the continental style public toilet and weekly, would buy a lottery ticket where I buy my paper.

I often wondered where she slept at night, especially on cold snowy nights. One morning, she was asleep in the bus station, lying in an enclosed corner - but I only ever saw her there the one time.

I haven't seen her at all this year - so perhaps she succumbed to the elements last winter?

I can understand that your bag lady is now on your mind - it is hard to know what to do.

It doesn't seem right. It doesn't seem civilised- regardless of the economic climate to turn people out into the cold who have nowhere else to go. Of course I don't hold you personally responsible for what you did as it's not exactly your fault things are set up that way, but I'm just saying, it doesn't seem right at all. How would you feel if she returns to the hospital with frostbite or pneumonia? I'm not saying hospitals should take in everyone, but it's kinda false economy if such people return injured by the elements.

The chances are she might resort to petty theft or disorderly conduct in the hope of being able to sleep in a cell or something.

Of course, Neelu, you are quite right but helping these people is more difficult than you might think. The more experienced you are the more you realise that. There is a story I often tell on ward rounds related to this. Your comment might just persuade me to relate it here in an accompanying post. The only problem is that it is about a particular patient so I need to be careful.

"How would you feel if she returns to the hospital with frostbite or pneumonia" - ahh, that might be different.

If you have an acute medical medical problem, such as the conditions you mention, then you might need a bed - even if others in the waiting room are doing their level best to avoid any close contact with such patients (a problem that also applies to some staff if we are honest).

Needless to say the homeless are particularly susceptible to both physical AND mental health problems - especially this this time of year.http://www.york.ac.uk/inst/chp/bines.pdf

But the point Neelu makes is that if Dr Grumble had taken her into his home he might have prevented her from getting frostbite or pneumonia. Doesn't society have a duty to look after somebody like the bag lady? The hospital definitely won't though Dr G can remember the time when we did admit such people to protect them from the cold and give them a wash and brush up. These days with managers breathing down your neck that is not an option.

"Doesn't society have a duty to look after somebody like the bag lady" - there are services, although not always as responsive or accessible as some would like.

On very cold nights homeless patients usually doss down in the A&E waiting room and blankets are given and a hot drink - they are directed to the homeless persons unit in the morning, or the night shelter if it is not too late in the evening.

God knows how the homeless survive in these conditions - as you know, not all do.http://www.crisis.org.uk/data/files/publications/still%20dying%20for%20a%20home.pdf

According to the Crises report the average age of death for a rough sleeper dying from natural causes is 46 - while rough sleepers are four times more likely to die from unnatural causes.

30 years ago the bag lady of Barts' used to "reside" at night on a bench seat near the lifts on the ground floor of the QE2 (Neurosurgical) block. As one of the duty (admin) officers - around 1980 - I would walk around the site a few times if there was nothing else to attend to during a night shift. There was an unwritten rule among us that if the weather was cold or it was raining we would "turn a blind eye" to her. If it was mild and dry we would politely ask her to move on. Because it was an unwritten rule we all knew the routine and sometimes a smile and nod of the head towards the door was all that was required.

On one occasion I got it wrong. It was mild and dry when I asked her to move on - which she did with reluctance. It took her some time to gather up her belongings and by the time I finished my round and was walking back to the main ward blocks she was making her way towards St Pauls - in an icy rain!

No word was exchanged between us but it only took a look from her and a nod from me and when I next visited the ground floor of the QE2 block - a couple of hours later - she was warm and dry and back on "home ground".

Although we were encouraged to keep a log of all incidents and events I suspect that the official archives make no mention of her. I know I never did. In those days hospital administrators and managers contributed to the "business" of compassion and were not afraid to act based on their own judgement of what was right and wrong when needed.

I've been homeless. I've also slept rough when I wasn't homeless but was very ill.

It can be difficult finding somewhere to sleep. Shelters can be full, and if you do get a bed, they can be unsafe. They usually charge and getting benefits sorted out if you are homeless is easier said than done.

I've slept in a hospital chapel. These days, not many people seem to use them at night, so I was undisturbed.